Membership Form
Ema ‘O Mahpe Lodge #14
o
a
Order of the Arrow
Cimarron Council, BSA
Membership dues for the Ema ‘O Mahpe Lodge are $10 annually. Annual dues are due December 31. There is an
additional charge for Lodge flaps. Flaps, sashes and more are available through the Cimarron Council office.
First name: ________________________ Initial: _______ Last name: _____________________________________
Date of birth: ___/___/_____ Date of Ordeal: ___/___/_____ Brotherhood: ___/___/_____Vigil Honor: ___/___/_____
Location of Ordeal: _____________________ Brotherhood: ____________________ Vigil: ____________________
Vigil Honor Name: ______________________________________________________________________________
Vigil Honor Name Translation: ____________________________________________________________________
Address: __________________________________________________________________________ Apt. # _____
Town: ________________________________________________ State: ____________ Zip+4 ________________
Home phone (_____)__________ Business phone (_____)__________ Email: ______________________________
Boy Scouts of America Registration Number (from BSA membership card): ______________________________
You must be registered with the BSA to be an OA member. Contact your unit or call the Cimarron Council at
(580) 234.3652 to get your BSA registration number if you cannot find your BSA membership card.
Primary Registration: Pack/ Troop/ Post/ Crew/ District/ Council Unit #________ Adult Position _________________
Do you have Scouting skills that you want to share with our Lodge? Skills might include woodcarving, headdress making,
cooking or bull dozer driving: _______________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Please contact me. I want to get more involved in our Lodge. ____
If paying by check, make your check payable to “Cimarron Council, BSA” and write “OA” on your check and mail
to Cimarron Council, PO Box 3146, Enid, OK 73701. If you have questions about membership, contact
the Lodge Chief at